Basic Information
| Provider Information | |||||||||
| NPI: | 1912931973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 80 HEALTH PARK DR | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800279584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036652603 | ||||||||
| FaxNumber: | 3036652605 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 HEALTH PARK DR | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800279584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036652603 | ||||||||
| FaxNumber: | 3036652605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 44217 | CO | Y | Other Service Providers | Specialist |
No ID Information.